Department of Radiation Oncology, Zhongshan Hospital, Fudan University, No. 180 Feng Lin Road, Shanghai, 200032, China.
Clin Transl Oncol. 2017 Sep;19(9):1154-1160. doi: 10.1007/s12094-017-1654-x. Epub 2017 Mar 29.
Several studies have found benefits of radiotherapy for adrenal metastasis from hepatocellular carcinoma (HCC). However, the efficacy, safety and outcome issues have not yet been fully addressed. Therefore, we performed this study to further elucidate the feasibility and outcome of radiotherapy in treating adrenal metastasis from HCC.
We retrospectively analyzed 81 patients with adrenal metastasis from HCC between 2001 and 2015. Eighteen patients received helical tomotherapy and 63 patients received conventional radiotherapy, including two-dimensional (2-D) or three-dimensional conformal radiotherapy (3-D CRT). The median radiation dose was 50 Gy (range 26-64 Gy) with median fraction size of 2.0 Gy (range 2.0-5.0 Gy). Tumor responses, adverse effects, patient outcomes and prognostic factors were analyzed.
An objective response (complete and partial response) was achieved in 55.6% patients. The helical tomotherapy group showed higher objective response rate than the conventional radiotherapy group (P = 0.031). The major adverse effects were anorexia (51.8%), nausea (41.9%), and fatigue (35.8%). Similar toxicity profile occurred in the 2-D, 3-D CRT and helical tomotherapy groups. The overall survival (OS) rate at 1, 2 and 5 years was 59.9, 35.0, and 12.9%, respectively, with a median survival of 15 months. Patients who received helical tomotherapy achieved a better OS compared to the conventional radiotherapy group (P = 0.047). However, multivariate analysis indicated that radiotherapy technique was not an independent prognostic factor for patient outcome.
These results suggest that radiotherapy offers a noninvasive approach in controlling adrenal metastasis from HCC with promising local control and acceptable tolerability.
多项研究发现肝细胞癌（HCC）肾上腺转移患者接受放疗具有获益。然而，放疗的疗效、安全性和预后问题仍未得到充分解决。因此，我们进行了这项研究，以进一步阐明放疗治疗 HCC 肾上腺转移的可行性和结果。
我们回顾性分析了 2001 年至 2015 年间 81 例 HCC 肾上腺转移患者的临床资料。18 例患者接受螺旋断层放疗（Tomotherapy），63 例患者接受常规放疗，包括二维（2D）或三维适形放疗（3DCRT）。中位放疗剂量为 50Gy（范围 26-64Gy），中位分割剂量为 2.0Gy（范围 2.0-5.0Gy）。分析肿瘤反应、不良反应、患者结局和预后因素。
55.6%的患者获得客观缓解（完全缓解和部分缓解）。Tomotherapy 组的客观缓解率高于常规放疗组（P=0.031）。主要不良反应为厌食（51.8%）、恶心（41.9%）和乏力（35.8%）。2D、3DCRT 和 Tomotherapy 组的毒性谱相似。1、2 和 5 年总生存率（OS）分别为 59.9%、35.0%和 12.9%，中位 OS 为 15 个月。与常规放疗组相比，Tomotherapy 组患者的 OS 更好（P=0.047）。然而，多因素分析表明，放疗技术不是患者预后的独立预后因素。
这些结果表明，放疗为控制 HCC 肾上腺转移提供了一种非侵入性方法，具有良好的局部控制和可接受的耐受性。
